A national survey of clinicians' opinions of rotational vaginal births.

INTRODUCTION: Malposition of the fetal head, defined as occiput transverse or posterior positions, occurs in approximately 5% of births. At full cervical dilatation, fetal malposition is associated with an increased risk of rotational vaginal birth. There are three different rotational methods: manual rotation, rotational ventouse or rotational (Kielland's) forceps. In the absence of robust evidence, it is not currently known which of the three methods is most efficacious, and safest for parents and babies. OBJECTIVE: To gain greater insights into opinions and preferences of rotational birth to explore the acceptability and feasibility of performing a randomised trial comparing different rotational methods. MATERIAL AND METHODS: A survey was sent via email to obstetricians from the British Maternal Fetal Medicine Society, as well as expert obstetricians and active academics in ongoing research in the UK. The questions focussed on perceived competence, preferred rotational method, location (theatre or labour room), willingness to recruit to an RCT, and its outcome measures. Closed questions were followed by the option of free text to allow further comments. The free text answers underwent thematic analysis. RESULTS: 252 consultant obstetricians responded. The majority stated they were competent in performing manual rotation (88.1%). Half felt proficient using Kielland's rotational forceps (54.4%). Most obstetricians felt skilled in rotational ventouse (76.2%). Manual rotation was the preferred first rotational method of choice in cases of both occiput transverse and posterior positions. The decision for which rotational method to attempt first was considered case-dependent by many. Two thirds of obstetricians would usually conduct rotational births in theatre (67.9%). Over half (52%) do not routinely use intrapartum ultrasound. Most (62.7%) would be willing to recruit to a randomised controlled trial comparing manual versus instrumental rotation. Over half (57.2%) would be willing to recruit to the same RCT if they were the most senior doctor competent in rotational vaginal birth supervising a junior. CONCLUSION: There is a wide range of practice in conducting rotational vaginal births in the UK. An RCT to investigate the impact of different rotational methods on outcome would be both feasible and desirable, especially in research-active hospitals.

Is There Still a Place for Forceps Delivery in Modern Obstetrics?

BACKGROUND: Nowadays, we are witnessing a decrease of vaginal instrumental deliveries and continuous increase of caesarean section rate. However, proper identification of possibility of execution, indications for instrumental delivery and their skilful use may improve the broadly understood maternal and neonatal outcomes. The aim of this study is to present prevalence, risk factors, indications and outcomes of forceps deliveries among the patients at Department of Perinatology, Lodz. MATERIAL AND METHODS: A retrospective study was conducted at the Department of Perinatology, Medical University of Lodz. The study included forceps deliveries carried out between January 2019 and December 2022. Total number of 147 cases were analysed in terms of indications for forceps delivery and maternal and neonatal outcomes such as vaginal - or cervical - laceration, postpartum haemorrhage, perineal tear, newborn injuries, Apgar score, umbilical cord blood gas analysis, NICU admission and cranial ultrasound scans. RESULTS: The prevalence of forceps delivery was 2.2%. The most common indication for forceps delivery was foetal distress (81.6%). Among mothers, the most frequent complication was vaginal laceration (40.1%). Third-and fourth-degree perineal tears were not noted. Regarding neonatal outcomes, Apgar score ≥ 8 after 1st and 5th minute of life received accordingly 91.2% and 98% of newborns. Only 8.8% experienced severe birth injuries (subperiosteal haematoma, clavicle fracture). CONCLUSIONS: Although foetal distress is the most common indication for forceps delivery, the vast majority of newborns were born in good condition and did not require admission to NICU. Taking into consideration high efficacy and low risk of neonatal and maternal complications, forceps should remain in modern obstetrics.

Severe neonatal birth injury: Observational study of associations with operative, cesarean, and spontaneous vaginal delivery.

AIM: To determine the association of successful and unsuccessful operative vaginal delivery attempts with risk of severe neonatal birth injury. METHODS: We conducted a population-based observational study of 1 080 503 births between 2006 and 2019 in Quebec, Canada. The main exposure was operative vaginal delivery with forceps or vacuum, elective or emergency cesarean with or without an operative vaginal attempt, and spontaneous delivery. The outcome was severe birth injury, including intracranial hemorrhage, brain and spinal damage, Erb's paralysis and other brachial plexus injuries, epicranial subaponeurotic hemorrhage, skull and long bone fractures, and liver, spleen, and other neonatal body injuries. We determined the association of delivery mode with risk of severe birth injury using adjusted risk ratios (RR) and 95% confidence intervals (CI). RESULTS: A total of 8194 infants (0.8%) had severe birth injuries. Compared with spontaneous delivery, vacuum (RR 2.98, 95% CI 2.80-3.16) and forceps (RR 3.35, 95% CI 3.07-3.66) were both associated with risk of severe injury. Forceps was associated with intracranial hemorrhage (RR 16.4, 95% CI 10.1-26.6) and brain and spinal damage (RR 13.5, 95% CI 5.72-32.0), while vacuum was associated with epicranial subaponeurotic hemorrhage (RR 27.5, 95% CI 20.8-36.4) and skull fractures (RR 2.04, 95% CI 1.86-2.25). Emergency cesarean after an unsuccessful operative attempt was associated with intracranial and epicranial subaponeurotic hemorrhage, but elective and other emergency cesareans were not associated with severe injury. CONCLUSIONS: Operative vaginal delivery and unsuccessful operative attempts that result in an emergency cesarean are associated with elevated risks of severe birth injury.

Operative vaginal delivery: practice patterns and outcomes at a tertiary general hospital.

Introduction: There has been a global decrease in operative vaginal deliveries, with a marked shift towards the vacuum extractor. However, little is known about the trends in operative vaginal delivery in Singapore. Methods: A retrospective study was conducted on all operative vaginal deliveries performed from 2012 to 2017 at Singapore General Hospital (SGH). Maternal outcomes in terms of postpartum haemorrhage and obstetric anal sphincter injuries were compared between forceps- and vacuum-assisted deliveries. Neonatal outcomes in terms of neonatal intensive care unit (NICU) admission and clinically significant neonatal events were compared. The instrument preference of obstetricians was analysed. Results: A total of 906 consecutive operative vaginal deliveries were included in the study, comprising 461 forceps- and 445 vacuum-assisted deliveries. The rate of operative vaginal delivery was maintained at approximately 10% from 2012 to 2017. Neonatal cephalohematomas were more common after vacuum-assisted deliveries. Other maternal and neonatal outcomes did not differ significantly between the two groups. Clinically significant neonatal events were mostly due to shoulder dystocia, whereas all cases of NICU admissions were not directly related to the mode of delivery. Obstetricians' choice of instrument appeared to reflect personal preference and was not affected by the year of graduation. Conclusion: The rates of neonatal and maternal morbidity were low at SGH. Overall instrument use of forceps and vacuum was balanced, and proficiency in both was demonstrated by all operators. Operative vaginal delivery remains an essential skill in facilitating safe vaginal delivery, which should be maintained to keep Caesarean section rates in check.

Operative vaginal delivery: practice patterns and outcomes at a tertiary general hospital

INTRODUCTION@#There has been a global decrease in operative vaginal deliveries, with a marked shift towards the vacuum extractor. However, little is known about the trends in operative vaginal delivery in Singapore.@*METHODS@#A retrospective study was conducted on all operative vaginal deliveries performed from 2012 to 2017 at Singapore General Hospital (SGH). Maternal outcomes in terms of postpartum haemorrhage and obstetric anal sphincter injuries were compared between forceps- and vacuum-assisted deliveries. Neonatal outcomes in terms of neonatal intensive care unit (NICU) admission and clinically significant neonatal events were compared. The instrument preference of obstetricians was analysed.@*RESULTS@#A total of 906 consecutive operative vaginal deliveries were included in the study, comprising 461 forceps- and 445 vacuum-assisted deliveries. The rate of operative vaginal delivery was maintained at approximately 10% from 2012 to 2017. Neonatal cephalohematomas were more common after vacuum-assisted deliveries. Other maternal and neonatal outcomes did not differ significantly between the two groups. Clinically significant neonatal events were mostly due to shoulder dystocia, whereas all cases of NICU admissions were not directly related to the mode of delivery. Obstetricians' choice of instrument appeared to reflect personal preference and was not affected by the year of graduation.@*CONCLUSION@#The rates of neonatal and maternal morbidity were low at SGH. Overall instrument use of forceps and vacuum was balanced, and proficiency in both was demonstrated by all operators. Operative vaginal delivery remains an essential skill in facilitating safe vaginal delivery, which should be maintained to keep Caesarean section rates in check.

Estimación de la frecuencia del parto vaginal instrumentado en Colombia en los años 2015 - 2019. Estudio transversal de registros poblacionales / Estimated frequency of instrumented vaginal delivery in Colombia between 2015 and 2019. Population registry-based cross-sectional study

Objetivos: evaluar la frecuencia del parto instrumentado en Colombia y por regiones entre el 2015 y 2019. Materiales y métodos: estudio de corte transversal a partir de registros poblacionales. Se incluyeron los registros de mujeres con edad gestacional mayor a 28 semanas y parto vaginal. Muestreo consecutivo. La información se obtuvo a partir del certificado de nacido vivo del Departamento Administrativo Nacional de Estadística (DANE). Se realizó la descripción de las variables sociodemográficas y clínicas. La frecuencia del parto instrumentado fue calculada y descrita por año y departamento. Resultados: se incluyeron 3.224.218 registros de recién nacidos vivos. De estos, 1.719.405 (53,33 %) correspondieron a partos vaginales, y 1.468.726 (45,55 %) a partos por vía cesárea. La frecuencia nacional del parto instrumentado entre el 2015 y 2019 fue de 36.087 nacimientos (1,11 %); Antioquia y Bogotá, D.C. fueron los lugares con mayor ocurrencia, 16.201 (4,5 %) y 13.686 (2,52 %), respectivamente. Conclusiones: el parto vaginal instrumentado es la vía de parto con menor ocurrencia en Colombia con tendencia a la disminución. La formación en este recurso para el uso durante el trabajo de parto no debe perderse en la formación del profesional de salud, especialmente en los programas de Ginecología y Obstetricia. Se debe evaluar si el aumento en el adecuado uso de esta técnica puede disminuir la tasa de cesáreas observadas actualmente, así como describir los escenarios clínicos donde su uso es seguro para la madre y el feto. Se requieren estudios prospectivos, pues pueden permitir establecer las causas del descenso en el uso de esta herramienta obstétrica, los resultados maternos y perinatales en términos de su riesgo/beneficio.

Objectives: To assess the frequency of instrumented delivery in Colombia and by regions between 2015 and 2019. Materials and methods: Cross-sectional study based on population registries. Records of women with a gestational age of more than 28 weeks and vaginal delivery were included. Consecutive sampling was used. The information was taken from live birth certificates of the National Administrative Department of Statistics (DANE). Sociodemographic and clinical variables were described. The frequency of instrumented deliveries was calculated and described by year and by department. Results: Overall, 3,224,218 live birth records were included. Of these 1,719,405 (53.33 %) were vaginal deliveries and 1,468,726 (45.55 %) were cesarean births. At a national level, the frequency of instrumented deliveries between 2015 and 2019 was 36,087 births (1.11 %); Antioquia and Bogotá, D.C. were the places with the highest occurrence, with 16,201 (4.5 %) and 13,686 (2.52 %), respectively. Conclusions: The occurrence of instrumented vaginal delivery in Colombia is the lowest and tends to diminish. Training of healthcare professionals in this approach during labor must not be abandoned, particularly in Obstetrics and Gynecology training programs. Further studies should be conducted to determine whether the increased adequate use of this technique could contribute to a lower rate of cesarean sections, and also to describe the clinical setting in which its use is safe for both the mother and the fetus. Prospective studies are required to identify the causes leading to the lower use of this obstetric tool as well as the risks and benefits in terms of maternal and perinatal outcomes.

Spatulas for operative vaginal birth: A systematic review and meta-analysis.

BACKGROUND: Operative vaginal birth represents an alternative to address problems during the second stage of labor. Obstetricians have access to three different instruments: forceps, vacuum, and spatulas. OBJECTIVE: To evaluate the safety and effectiveness of the use of spatulas for operative vaginal birth. SEARCH STRATEGY: MEDLINE/PubMed, Embase, CENTRAL, LILACS, SciELO, ClinicalTrials.gov, and OpenGrey. SELECTION CRITERIA: Randomized controlled studies and non-randomized controlled studies (NRS) were included. DATA COLLECTION AND ANALYSIS: Studies were independently assessed for inclusion, data extraction, and risk of bias. MAIN RESULTS: Nine NRS (n = 16  497 women) compared the use of spatulas versus forceps. Low-certainty evidence suggests that spatulas were not different in terms of failed operative vaginal delivery rate (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.53-1.52), but may decrease the incidence of birth canal trauma (OR 0.70, 95% CI 0.54-0.91), birth canal laceration (OR 0.50, 95% CI 0.28-0.91), and neonatal soft-tissue injury (OR 0.19, 95% CI 0.13-0.29). Six NRS (n = 2992 women) compared the use of spatulas versus vacuum. Low-quality evidence suggests that spatulas may decrease failed operative vaginal delivery rate (OR 0.10, 95% CI 0.04-0.26). There were no apparent differences in other maternal and neonatal outcomes. CONCLUSION: Low-certainty evidence suggests that spatulas could be a safe and effective alternative for operative vaginal birth.

Estimated frequency of instrumented vaginal delivery in Colombia between 2015 and 2019. Population registry-based cross-sectional study / Estimación de la frecuencia del parto vaginal instrumentado en Colombia en los años 2015 ­ 2019. Estudio transversal de registros poblacionales

Objectives: To assess the frequency of instrumented delivery in Colombia and by regions between 2015 and 2019. Materials and methods: Cross-sectional study based on population registries. Records of women with a gestational age of more than 28 weeks and vaginal delivery were included. Consecutive sampling was used. The information was taken from live birth certificates of the National Administrative Department of Statistics (DANE). Sociodemographic and clinical variables were described. The frequency of instrumented deliveries was calculated and described by year and by department. Results: Overall, 3,224,218 live birth records were included. Of these 1,719,405 (53.33 %) were vaginal deliveries and 1,468,726 (45.55 %) were cesarean births. At a national level, the frequency of instrumented deliveries between 2015 and 2019 was 36,087 births (1.11 %); Antioquia and Bogotá, D.C. were the places with the highest occurrence, with 16,201 (4.5 %) and 13,686 (2.52 %), respectively. Conclusions: The occurrence of instrumented vaginal delivery in Colombia is the lowest and tends to diminish. Training of healthcare professionals in this approach during labor must not be abandoned, particularly in Obstetrics and Gynecology training programs. Further studies should be conducted to determine whether the increased adequate use of this technique could contribute to a lower rate of cesarean sections, and also to describe the clinical setting in which its use is safe for both the mother and the fetus. Prospective studies are required to identify the causes leading to the lower use of this obstetric tool as well as the risks and benefits in terms of maternal and perinatal outcomes.

Objetivos: evaluar la frecuencia del parto instrumentado en Colombia y por regiones entre el 2015 y 2019. Materiales y métodos: estudio de corte transversal a partir de registros poblacionales. Se incluyeron los registros de mujeres con edad gestacional mayor a 28 semanas y parto vaginal. Muestreo consecutivo. La información se obtuvo a partir del certificado de nacido vivo del Departamento Administrativo Nacional de Estadística (DANE). Se realizó la descripción de las variables sociodemográficas y clínicas. La frecuencia del parto instrumentado fue calculada y descrita por año y departamento. Resultados: se incluyeron 3.224.218 registros de recién nacidos vivos. De estos, 1.719.405 (53,33 %) correspondieron a partos vaginales, y 1.468.726 (45,55 %) a partos por vía cesárea. La frecuencia nacional del parto instrumentado entre el 2015 y 2019 fue de 36.087 nacimientos (1,11 %); Antioquia y Bogotá, D.C. fueron los lugares con mayor ocurrencia, 16.201 (4,5 %) y 13.686 (2,52 %), respectivamente. Conclusiones: el parto vaginal instrumentado es la vía de parto con menor ocurrencia en Colombia con tendencia a la disminución. La formación en este recurso para el uso durante el trabajo de parto no debe perderse en la formación del profesional de salud, especialmente en los programas de Ginecología y Obstetricia. Se debe evaluar si el aumento en el adecuado uso de esta técnica puede disminuir la tasa de cesáreas observadas actualmente, así como describir los escenarios clínicos donde su uso es seguro para la madre y el feto. Se requieren estudios prospectivos, pues pueden permitir establecer las causas del descenso en el uso de esta herramienta obstétrica, los resultados maternos y perinatales en términos de su riesgo/beneficio.

Has the prevalence of levator avulsion after forceps delivery changed over the last six decades? A retrospective study in a urogynaecological population.

OBJECTIVE: Forceps delivery is associated with a higher risk of maternal birth trauma. It is speculated that it is due to sub-optimal use of forceps in inexperienced hands. The aim of this study was to determine the association between time of forceps birth and prevalence of levator avulsion over the last six decades. STUDY DESIGN: This was a retrospective analysis of datasets of women with a history of forceps delivery, seen at a tertiary urogynaecological centre between January 2014 and August 2018. They had undergone a standardized interview, clinical examination and four-dimensional translabial ultrasound. Archived imaging data was reviewed for levator avulsion offline at a later date, blinded against all clinical data. Associations between levator avulsion, maternal age at first vaginal birth, the weight of the first vaginally born baby, and time since forceps delivery categorised by decade were tested by univariable analysis. Factors found to be significant on univariable analysis were included in a multivariable logistic regression model to test the association between prevalence of levator avulsion and time of forceps delivery while controlling for confounders. RESULTS: In total, 2026 patients were seen during the study period. Among them 511 (25.2%) had a history of forceps delivery. Fourteen volume datasets were incomplete or missing, leaving 497 complete datasets for analysis. Mean age at presentation was 58 ± 12 years (23-91). Mean body mass index was 29 ± 6 kg/m2. Mean age at first delivery was 25 ± 5 years. Mean birth weight of the first vaginal birth was 3454 ± 557 g. 457 women (92%) had had one forceps delivery, 31 had two forceps deliveries (6%) and 9 had three forceps deliveries (2%). Mean time interval between forceps delivery and assessment was 32 ± 13 years (0.3-64.8). 229 women (46%) were diagnosed with levator avulsion. The prevalence of avulsion after forceps increased significantly from 34% to 56% between 1950 and 2017 (P = 0.04). However this difference became insignificant when controlling for maternal age at 1st vaginal delivery and birth weight. CONCLUSIONS: We found no evidence of a changed prevalence of levator avulsion at forceps delivery over the last 67 years.

How do pregnant women's perceptions of obstetric forceps change according to their demographic background: a cross sectional study.

BACKGROUND: Women's attitudes towards obstetric forceps likely contribute to declining use and opportunities for residency training, but formal documentation of women's attitudes towards obstetric forceps is currently limited. A clearer understanding should help guide our attempts to preserve its use in modern obstetrics and to improve residency training. Our objective is to document women's attitudes towards obstetric forceps and the influence basic demographic variables have on those attitudes. METHODS: A cross sectional study was performed. We developed a one-time anonymous structured 5-question survey that was given to all women with low-risk pregnancies presenting to our medical center for prenatal care between October 2018-December 2018. The questionnaire asked for the woman's self-reported age, race, education level and insurance type. The five questions were as follows: (1) Do you think forceps should be used to deliver babies, (2) Is forceps safe for the baby, (3) Is forceps safe for the mother, (4) Do you think forceps can help to lower the cesarean section rate, (5) Do you think physicians in training should learn to place forceps on a real patient. We calculated means and proportions for the responses according to the overall group and various subgroups. Statistical analysis included Kruskall-Wallis or Mann-Whitney tests as appropriate. Results were also adjusted by regression using a Generalized Linear Model. Power calculation showed sample size of 384 was required. RESULTS: A total of 499 women returned the questionnaire. Response rate was 56.8% (499/878). The findings suggest that women's perceptions towards forceps are generally negative. Women with white ethnicity, college education or higher and private insurance did have more favorable views than their counterparts, but the majority still had unfavorable views. Age was not shown to have a significant effect on maternal attitude. CONCLUSION: Women's views towards forceps use in the University of Kansas Medical Center are negative and may be contributing to the decline of its use. Improving women's perceptions of forceps would require multiple different strategies rather than a single focused easily-implemented message. If forceps training continues, such training will rely on a minority of women who will accept forceps use in childbirth.

Obstetric forceps dimensions and the newborn head biometry: Time for an update.

Obstetric forceps were invented in the 1600s to assist vaginal delivery of term babies following prolonged labour. This probably explains their design, with a narrow interblade distance and long blade length, to fit a severely moulded fetal head. However, in modern obstetric practice protracted labour is avoided, yet our research has shown that over 400 years forceps dimensions have remained largely unchanged. We believe it is time to optimise these dimensions based on biometry of the term, newborn baby's head, with the head width (biparietal diameter) and head length (mentovertical diameter) correlating with interblade distance and blade length respectively. We hypothesise that doing so should reduce the incidence of neonatal complications associated with forceps assisted delivery and it is also possible that the amended shape might be associated with better outcomes for women. In this article we present our rationale for the optimisation of the forceps dimensions based on the findings of our previous systematic review and an original series of mentovertical and biparietal diameter measurements using laser scanning technology.

Perceived satisfaction of women during labour at the Hospital Universitario Materno-Infantil of the Canary Islands through the Childbirth Experience Questionnaire (CEQ-E). / Satisfacción percibida por las mujeres durante el parto en el Hospital Universitario Materno-Infantil de Canarias a través del Childbirth Experience Questionnaire (CEQ-E).

OBJECTIVE: To determine the degree of satisfaction of women after childbirth at the Hospital Universitario Materno-Infantil of Gran Canaria (HUMIC) and to establish possible relationships between the degree of satisfaction and the variables studied. METHOD: A cross-sectional, descriptive, observational study with an analytical component. The study population comprised women who gave birth at the HUMIC in November 2018, recruited through consecutive non-probabilistic sampling. The Spanish version of the Childbirth Experience Questionnaire (CEQ-E) was used (questionnaire with 4 domains: own capacity', professional support, perceived safety and participation/analytical model 2). In a first phase a descriptive analysis was made, and in a second phase an inferential analysis to explore the association between different variables. RESULTS: The total sample comprised 257 women (n=257). The total score using the CEQ was 3.24 (SD .37 points). No statistically significant differences were found in the final CEQ score between the women who had a spontaneous delivery versus induction-stimulation (P=.563) or between primiparous versus multiparous women (P=.060). The women whose labour lasted 12hours or less (P=.024), without perineal trauma (P=.021) and those who had not undergone episiotomy (P=.002) achieved a better final CEQ score. Instrumental delivery (forceps) versus normal delivery is associated with lower scores with respect to the final CEQ-E score (P=≤.001). CONCLUSIONS: Women's overall satisfaction after delivery in HUMIC was high. Instrumental delivery seems to be associated with lower perceived satisfaction. Aspects such as fear and fatigue in labour could affect satisfaction negatively. These aspects can be improved by establishing strategies to increase comfort and minimise pregnant women's fear of labour.

Training the skills of obstetric forceps delivery for resident doctors by using simulation teaching method / 中华医学教育探索杂志

In this study, 15 second-year resident doctors who had standardized training of OBGYN were taken as research subjects to discuss the effect of training resident doctors with obstetrics forceps by using simulation teaching method. The simulation teaching process includes theoretical study, theoretical examination, simulation teaching of forceps skills and Assessment of forceps skills. In theoretical study section: before learning to use forceps, the students acquired the theoretical knowledge by flipped teaching micro-video mode. In theoretical examination section: the mastery of basic clinical knowledge of using forceps was evaluated through online assessment. In simulation teaching of forceps skills: students who scored 8/10 points were admitted to enter the simulation teaching process, and they had practical training of scenario simulation skills in Clinical Skills Center. In assessment of forceps skills: the mastery of forceps skills was evaluated by standardized forceps delivery procedure items. The results showed that the students in the simulation teaching group had excellent teaching assessment results, and the resident doctors had more confidence in operating forceps independently, and the teaching effect was ideal, which could further promote the simulation teaching of obstetric clinical skills.

Exploring the newborn head diameters in relation to current obstetric forceps' dimensions: A systematic review.

OBJECTIVE: The aim of this study was to systematically search the literature for studies that reported term neonate head size and shape, in an attempt to determine the most appropriate dimensions for the obstetric forceps. STUDY DESIGN: We searched the Ovid Medline, Ovid Embase and Ebscohost CINAHL databases from inception to February 2016. We predefined inclusion criteria to identify studies in which head width and length of asymptomatic, term neonates were measured soon after birth using direct, non-photographic methods A bespoke quality assessment score was used to evaluate the identified studies. RESULTS: Seven studies were identified which measured head width (biparietal diameter) in 551 neonates; giving a mean value of 94.0mm (range 90.7mm-95.5mm). We identified one study which measured head length (mentovertical diameter) in 38 neonates; which gave a mean value of 134.5mm (range 129mm-139mm). CONCLUSION: This data, in conjunction with measurements of Neville Barnes' and Wrigley's forceps from our previous study, indicates current obstetric forceps' blades are too long, and close together. Potentially, this could be contributing to neonatal and maternal injuries associated with operational vaginal deliveries.

A prospective randomized study comparing maternal and fetal effects of forceps delivery and vacuum extraction.

OBJECTIVE: To compare maternal and neonatal effects of assisted vaginal delivery by forceps and vacuum extraction. METHODS: A prospective randomized study. One hundred eligible women requiring assisted vaginal delivery in the second stage of labor were randomized to deliver by forceps or vacuum extraction. RESULTS: All of those allocated to forceps delivery actually delivered with the allocated instrument (100 % delivery rate in forceps vs. 90 % in VE); however, maternal trauma (40 % in forceps vs. 10 % in VE, p < 0.001), use of analgesia (p < 0.001), and blood loss at delivery (234 ml in VE vs. 337 ml in forceps group, p < 0.05) were significantly less in the group allocated to deliver by vacuum extraction. Vacuum extraction, however, appears to predispose to an increase in neonatal jaundice and incidence of cephalhematoma. More serious neonatal morbidity was rare in both groups. CONCLUSION: Extrapolation of the data from the study reveals that there is a significant reduction in maternal injuries. However, vacuum extraction has the potential to injure babies more.

Is it Time to Rejuvenate the Forceps?

The obstetric forceps was designed to assist extraction of the foetal head and thereby accomplish delivery of the foetus in the second stage of labour. More than 700 types of obstetric forceps have been described. An understanding of the anatomy of the birth canal and the foetal head is a prerequisite to becoming a skilled and safe user of forceps. Operative vaginal delivery rates have remained stable at between 10 and 13 %. The last few decades has seen a rise in caesarean section, along with the introduction and safe use of the vacuum extractor. This has resulted in a decline both in the use of the obstetric forceps as well as in the training for the same. The forceps is less likely to fail when used as the primary instrument thereby reducing the need for the sequential use of two instruments which increase the morbidity of the neonate. Perineal trauma is more likely to occur with the use of the forceps but the evidence is that the maternal concern is less when compared to the ventouse. Simulation training is an important part of obstetric training. Application of forceps blades in the simulation setting can improve the skill level of obstetricians. The use of the forceps should not be decreasing and more senior involvement in training is necessary so that juniors develop the proper skills to perform forceps delivery in a competent and safe manner. It is vital that the art of the forceps is not lost to future generations of obstetricians and the women they care for.